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a <br /> s <br /> Rev 2/23/2001 <br /> Y x Page 2 of 6 <br /> 0 Did you observe evidence or do you have any prior Yes No Unk <br /> 3 knowledge that any adjoining property used as a gasoline <br /> station, motor repair facility, dry cleaners, photo developing <br /> r laboratory, junkyard of landfill, or as a waste treatment, <br /> storage, disposal, processing, or recycling facility(if <br /> applicable, identify which)9 <br /> 5a Are there currently any damaged or discarded Yes No Unk <br /> automotive or industrial batteries, pesticides, paints, or <br /> other chemicals m individual containers of>5 gal (19L) in <br /> f volume or 50 gal (190L) in the aggregate, stored on or used <br /> at the property or at this facility's <br /> 5b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there have been previously any damaged or <br /> discarded automoti,,e or industrial batteries, pesticides, <br /> paints, or other chemicals m individual containers of>5 gal. <br /> (I 9L) in volume or 50 gal (190L) in the aggregate, stored <br /> on or used at the property or at this facility? <br /> 6a Are there currently any industrial drums(typically 55 Yes No Unk <br /> gal (208L)) or sacks of chemicals located on the property or <br /> at the facility? <br /> 6b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there have been previously any industrial , <br /> drums (typically 55 gal (208L))or sacks of chemicals <br /> located on the property or at the facility? <br /> 7a Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge thatfill dirt has been brought onto the property <br /> that originated from a contaminated Site <br /> 7l, Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that fill dirt has been brought onto the property <br /> that is of an unknown origin? <br /> 8a Are there currently any pits,ponds, or lagoons located Yes No ' Unk <br /> on the property in connection with waste treatment or waste <br /> disposal? <br /> 8b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there have been previously, any pits,ponds, <br /> or lagoons located on the property in connection with waste <br /> treatment or waste disposal? <br /> 9a is there currently any stained soil on the property? Yes No Unk <br /> a <br /> 9b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there has been previously any stained soil <br /> . on the property <br /> Initials <br />